Workers' Compensation Claims Examiner

LS Solutions; Temescal Valley (CA); On-site; USD 90,000 - 170,000; Full time

Job summary

LS Solutions in Temescal Valley, CA is seeking a Senior Claims Examiner to manage a portfolio of complex workers’ compensation claims from initial report through resolution. Investigate claim details and coverage, analyze medical and legal documentation, and establish and adjust reserves based on claim activity and exposure.

Negotiate and resolve settlements while ensuring full compliance with applicable state regulations and internal standards.

Qualifications

• Experience handling complex workers’ compensation claims.
• Ability to review medical and legal documentation.
• Knowledge of reserves and liability evaluation.
• Strong negotiation and settlement skills.
• Familiarity with relevant state regulations.
• Client-focused, ethical, and collaborative approach.

Responsibilities

• Manage a portfolio of complex workers’ compensation claims from initial report through resolution.
• Investigate claim details and coverage; analyze medical and legal documentation.
• Establish and adjust reserves based on claim activity and exposure.
• Negotiate and resolve settlements while ensuring compliance with state regulations and internal standards.
• Collaborate with brokers, risk managers, and medical providers to support informed decision-making.

Skills

Workers’ compensation claims handling

Investigation of coverage

Medical & legal documentation review

Reserves establishment & adjustment

Negotiation & settlements

State compliance knowledge

Client-focused & collaborative mindset

Job description

Senior Claims Examiner, Workers’ Compensation

Manage a portfolio of complex workers’ compensation claims from initial report through resolution. Investigate claim details and coverage, analyze medical and legal documentation, and establish and adjust reserves based on claim activity and exposure.

Senior Claims Examiner, Workers’ Compensation

Manage a portfolio of complex workers’ compensation claims from initial report through resolution. Investigate claim details and coverage, analyze medical and legal documentation, and establish and adjust reserves based on claim activity and exposure. Negotiate and resolve settlements while ensuring full compliance with applicable state regulations and internal standards. Partner with brokers, risk managers, and medical providers to support informed decision-making, control claim costs, and improve outcomes.

Key Skills & Qualifications

• Strong workers’ compensation claims handling experience


• Ability to investigate coverage and assess liability


• Proficiency in reviewing medical and legal documentation


• Experience establishing and adjusting reserves


• Skilled negotiation and settlement management


• Knowledge of state compliance requirements


• Client-focused, ethical, and collaborative mindset